Evaluation of liver fibrosis by transient elastography (FibroScan®) in rheumatic patients during methotrexate treatment

• Main Authors: Hariklia Kranidioti, Spilios Manolakopoulos, Anna Kandili, Xenophon Papacharalampous, Dimitrios Pectasides, Dimitrios Vassilopoulos
• Format: Article
• Language: English
• Published: PCO Convin S.A. 2016-01-01
• Series: Mediterranean Journal of Rheumatology
• Subjects: methotrexate; liver fibrosis; rheumatoid arthritis; psoriatic arthritis; elastography
• Online Access: https://www.mjrheum.org/assets/files/792/file38_996.pdf

Background: Liver fibrosis is an infrequent complication of methotrexate (MTX) treatment diagnosed by liver biopsy, an invasive procedure rarely used in clinical practice. Objectives: To evaluate liver fibrosis by transient elastography (TE, FibroScan®) in MTX treated rheumatic patients. Methods: This was a cross-sectional study of rheumatic patients treated with MTX (n=70) and controls (rheumatic patients not on MTX, n=24). Liver fibrosis was assessed blindly by TE. Eleven patients had repeated measurements during MTX treatment. Results: No baseline differences were noted between the 2 groups. The mean cumulative MTX dose was 1807±1846mg while the median treatment duration was 28 months. The mean liver stiffness of MTX treated patients was 5.9±2.1kPa compared to 6.5±3.6kPa of controls (p=0.755). Liver stiffness >7.1kPa (significant liver fibrosis) was observed in 21.5% of patients and 37.5% of controls (p=0.174). There was no correlation between cumulative MTX dose and liver stiffness (Spearman rho p=0.668 r=0.46) and no difference between patients who had received >1.5g (5.7±2.0kPa) compared to those treated with <1.5g of MTX (6±2kPa, p=0.244). Using multivariate analysis, only γ-GT levels were significantly associated with liver stiffness (p=0.01). In longitudinally followed patients, MTX caused a mild, non-significant increase in liver stiffness (from 6±2.3kPa to 6.7±2kPa, p=0.484). Conclusions: Long-term MTX administration is not associated with significant liver fibrosis in rheumatic patients, as assessed by TE. This method could be a useful tool for the screening and monitoring of liver fibrosis during MTX treatment.